Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships

Jerardi, Karen; Fisher, Erin; Rassbach, Caroline E.; Maniscalco, Jennifer; Blankenburg, Rebecca; Chase, Lindsay; Shah, Neha

doi:10.1542/peds.2017-0698

Cited by 40 publications

(44 citation statements)

References 14 publications

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“…Smallervolume NCHs should consider how to maintain adequate staffing and proficiency to care for TDC or may find it is more feasible to regionalize their care and transfer the TDC with rare conditions to the closest CHs. Current Pediatric Hospital Medicine Core Competencies include the care of TDC, 26 and these competencies should be part of the training of pediatric hospitalist fellows 27 as well as ongoing education for hospitalists to maintain the skills to care for this population regardless of hospital setting.…”

Section: Discussionmentioning

confidence: 99%

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Ahuja

Mack

Russell

2020

Hospital Pediatrics

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BACKGROUND AND OBJECTIVE: Technology-dependent children (TDC) are admitted to both children's hospitals (CHs) and nonchildren's hospitals (NCHs), where there may be fewer pediatricspecific specialists or resources. Our objective was to compare the characteristics of TDC admitted to CHs versus NCHs.METHODS: This was a multicenter, retrospective study using the 2012 Kids' Inpatient Database. We included patients aged 0 to 18 years with a tracheostomy, gastrostomy, and/or ventricular shunt. We excluded those who died, were transferred into or out of the hospital, had a length of stay (LOS) that was an extreme outlier, or had missing data for key variables. We compared patient and hospital characteristics across CH versus NCH using x 2 tests and LOS and cost using generalized linear models. RESULTS:In the final sample of 64 521 discharges, 55% of discharges of TDC were from NCHs. A larger proportion of those from CHs had higher disease severity (55% vs 49%; P , .001) and a major surgical procedure during hospitalization (28% vs 24%; P , .001). In an adjusted generalized linear model, the mean LOS was 4 days at both hospital types, but discharge from a CH was associated with a higher adjusted mean cost ($16 754 vs $12 023; P , .001). CONCLUSIONS:Because the majority of TDC are hospitalized at NCHs, future research on TDC should incorporate NCH settings. Further studies should investigate if some may benefit from regionalization of care or earlier transfer to a CH.

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Section: Discussionmentioning

confidence: 99%

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Ahuja

Mack

Russell

2020

Hospital Pediatrics

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“…2 The curriculum allows signifi cant fl exibility to meet diverse needs, including tailored content for fellows planning to practice in community settings, fellows planning research careers, medicine-pediatrics hospitalist careers, and those desiring increased training in QI, medical education, or leadership/administration. 2 In the spring of 2019, Pediatric Research in Inpatient Settings (PRIS) leadership, directors of existing PHM fellowship programs, and national academic society representatives met to develop a fellows' research curriculum, training resources, and guidelines around scholarship expectations. 9 This collaboration aims to accelerate the growth of high-quality clinical training and scholarship to benefi t hospitalized children across many different settings.…”

Section: Fellowship Training and The Phm Pipelinementioning

confidence: 99%

“…These skills and qualifi cations are delineated in the PHM core competencies and national fellowship curriculum. 1,2 In order to realize the vision of PHM to improve care for hospitalized children described by Roberts et al, 3 concerted efforts are needed to train and retain a workforce that is equipped with the skills to catalyze improvements in inpatient pediatric care. We discuss challenges and opportunities facing PHM in workforce development, sustainability of clinical work models, and interhospital collaboration.…”

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confidence: 99%

The Future of Pediatric Hospital Medicine: Challenges and Opportunities

Wang

Shaughnessy

Leyenaar

2020

Journal of Hospital Medicine

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P ediatric hospital medicine (PHM) is in the midst of an exciting period of growth. In 2016, the American Board of Medical Specialties approved the petition for PHM to become the newest pediatric subspecialty, taking PHM on a divergent path from the Focused Practice in Hospital Medicine designation established for adult hospitalists. Establishment as a subspecialty has allowed PHM to defi ne the unique skills and qualifi cations that hospitalists bring to patients and the healthcare system. These skills and qualifi cations are delineated in the PHM core competencies and national fellowship curriculum. 1,2 In order to realize the vision of PHM to improve care for hospitalized children described by Roberts et al., 3 concerted efforts are needed to train and retain a workforce that is equipped with the skills to catalyze improvements in inpatient pediatric care. We discuss challenges and opportunities facing PHM in workforce development, sustainability of clinical work models, and interhospital collaboration. FELLOWSHIP TRAINING AND THE PHM PIPELINEThe development of PHM as a subspecialty was driven by a number of factors. 4 The acuity of hospitalized children has increased signifi cantly, with a population comprised of more children with complex chronic conditions and/or technology dependence, serious complications of acute conditions, and acute mental health problems. At the same time, the medical and behavioral conditions seen by outpatient general pediatricians have become more complex and time intensive, with these practitioners less likely to work in inpatient settings. Hospitalist care has positive impacts on healthcare effi ciency and value, and both parents and primary care pediatricians report high levels of satisfaction with the healthcare delivered by PHM services. 4 A national count of the number of pediatric hospitalists is currently lacking. Conservative estimates suggest that at least 3,000 pediatric hospitalists currently practice in the United States. 5 These hospitalists have highly varied scopes of practice and work across diverse settings-more diverse, perhaps, than any other pediatric subspecialty. Although diffi cult to quantify, we estimate that approximately one-third of pediatric hospitalists in the US work in community hospitals and the remainder practice at children's hospitals. 6 Many of the needs of hospitalized children differ across these settings, and the roles and challenges faced by hospitalists in these settings correspondingly differ. Community hospitalists frequently take active roles in newborn care and emergency department consultation, often without the support of other pediatric subspecialties. 7 In contrast, hospitalists working at children's hospitals more frequently care for highly complex patients, often collaborate across multiple specialties and assume nonclinical roles in quality improvement (QI), research, and medical education.

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“…Pediatric hospital medicine (PHM) was recognized as the newest pediatric subspecialty by the American Board of Pediatrics in 2017. This was after the development of specialty-specific core competencies, 1 entrustable professional activities, 2 and a curricular framework for fellowship, 3 which highlight the unique characteristics of PHM. Many specialties and subspecialties offer undergraduate medical electives or focused experiences to support recruitment of talented students, 4 and at the resident level, exposure to practicing hospitalists is linked to increased interest in PHM as a career.…”

mentioning

confidence: 99%

Medical Student Training in Pediatric Hospital Medicine: A National Survey of Pediatric Clerkships

Trost¹,

Barqadle²,

Rudnick³

et al. 2019

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: Medical student electives offer opportunities for career exploration; it is unknown if electives exist for the newest pediatric subspecialty, pediatric hospital medicine (PHM), or how PHM competencies are already addressed in required medical student training. Our objectives for this study were (1) to determine the prevalence of exposure to PHM competencies in medical school and (2) to inform a needs assessment for a PHM elective. METHODS: A 5-item survey was distributed to members of the Council on Medical Student Education in Pediatrics as part of a larger survey in 2018. Descriptive statistics were used to report responses as proportions. Responses to 1 open-ended question were coded and grouped into categories. RESULTS: Of 152 total respondents, 118 (77.6%) answered at least 1 question. Respondents felt that quality improvement was addressed in preclinical years (40.4%), whereas systems-based practice was incorporated into core clerkships (32.1%). Although most indicated that leadership and education should be taught at the subinternship level (29.6% and 25%, respectively), those competencies are not currently integrated into subinternship rotations (7.4% and 4.8%, respectively). Approximately half (n 5 58; 49.5% each) reported that their institution offers a PHM elective. Lack of a standardized curriculum (16%) was seen as a barrier, and in free-text responses (n 5 33), respondents also noted concerns regarding saturation of inpatient settings and redundancy with required rotations. CONCLUSIONS: How to become a good leader and how to become a good educator were identified as PHM competencies that should be, but are not currently, taught at the fourth-year medical student level. A standardized curriculum and strategies to mitigate redundancy with existing rotations may increase satisfaction of students.

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Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships

Cited by 40 publications

References 14 publications

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

The Future of Pediatric Hospital Medicine: Challenges and Opportunities

Medical Student Training in Pediatric Hospital Medicine: A National Survey of Pediatric Clerkships

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